MyPriority HMO Silver 5500 Plan Details for 2021- HealthPocket

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Applicant Info
Applicant
Date of birth
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Gender
male
female
Income
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Zip Code	48228 (edit)
Applicant	2/27/1986 Male (edit)

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Insurance Type	ACA (Obamacare)
Plan Name	MyPriority HMO Silver 5500
Plan ID	hhs-29698MI0540450
Plan Year	2021
Insurance Provider	Priority Health
Metal Level	Silver
Plan Type	HMO
Deductible	$5,500
Out-of-Pocket Maximum	$8,550
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	$30 Copay
Specialist Visit	$65 Copay
Laboratory Outpatient and Professional Services	$10 Copay
X-rays and Diagnostic Imaging	30.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans	$150 Copay after deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Deductible - Family	$11000 per group
Out-of-Pocket Maximum - Family	$17100 per group

Prescription drug coverage
Generic Drugs	$5 Copay
Preferred Brand Drugs	$75 Copay
Non-Preferred Brand Drugs	$125 Copay
Specialty Drugs	50.00% Coinsurance after deductible

Access to doctors and hospitals
Provider directory URL	http://priorityhealth.prismisp.com/
Does this plan have access to a national provider network?	No
Is a referral required to see a Specialist?	Not Covered
Does this plan cover services outside plan service area?	Yes - Urgent/Emergency Care Only
Does this plan cover services outside the country?	Yes - Emergency Care Only

Hospital services
Emergency Room Services	$250 Copay after deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Hospital Services (e.g., Hospital Stay)	$500 Copay per Day after deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Physician and Surgical Services	30.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service	$250 Copay after deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.

Maternity
Prenatal and Postnatal Care	Not Applicable
Delivery and all inpatient services for maternity care	$500 Copay after deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.

Mental Health
Mental/Behavioral Health Outpatient Services	$30 Copay
Mental/Behavioral Health Inpatient Services	$500 Copay per Day after deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Substance use disorder outpatient services	$30 Copay
Substance use disorder inpatient services	$500 Copay per Day after deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.

Medical Management Programs
Does this plan offer disease managment programs?	Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
Does this plan offer a wellness program?	Not Covered

Vision Coverage
Routine Eye Exam for Children	Included
Eye Glasses for Children	Included
Routine Eye Exam for Adults	Not Covered

Child Dental Coverage
Child Dental Coverage - Routine Dental Care	Not Covered
Child Dental Coverage - Basic Dental Care	Not Covered
Child Dental Coverage - Orthodontia	Not Covered
Child Dental Coverage - Major Dental Care	Not Covered

Adult Dental Coverage
Adult Dental Coverage - Routine Dental Care	Not Covered
Adult Dental Coverage - Basic Dental Care	Not Covered
Adult Dental Coverage - Orthodontia	Not Covered
Adult Dental Coverage - Major Dental Care	Not Covered

Exclusions and Limitations
More Included Benefits	Other Practitioner Office Visit (Nurse, Physician Assistant) Preventive Care/Screening/Immunization Infertility Treatment Weight Loss Programs Imaging (CT/PET Scans, MRIs) Outpatient Surgery Physician/Surgical Services Urgent Care Centers or Facilities Inpatient Physician and Surgical Services Home Health Care Services Durable Medical Equipment Applied Behavior Analysis Based Therapies Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Prosthetic Devices Radiation Reconstructive Surgery Transplant Treatment for Temporomandibular Joint Disorders Well Baby Visits and Care Autism Spectrum Disorders Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited Benefits	Skilled Nursing Facility Bariatric Surgery Outpatient Rehabilitation Services Habilitation Services Hospice Services Chiropractic Care Nutritional Counseling Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy
More Excluded Benefits	Acupuncture Cosmetic Surgery Hearing Aids Private-Duty Nursing Dental Check-Up for Children Routine Foot Care Abortion for Which Public Funding is Prohibited Accidental Dental Long-Term/Custodial Nursing Home Care

+ See All Coverage Details

Premium	Plan Name	Deductible
from $274	HAP Personal Alliance HMO Genesys Choice Silver 5500	$5,500.00	Select
from $294	MyPriority HMO Silver 5500 - St. John Providence Network	$5,500.00	Select
from $305	MyPriority HMO Silver 5500 - Beaumont Health Network	$5,500.00	Select
from $306	MyPriority HMO Silver 5500 - St. Joseph Mercy Health System Net	$5,500.00	Select
from $308	HAP Personal Alliance HMO Henry Ford Choice Silver 5500	$5,500.00	Select

Last Name

Location/Distance

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Karen, Eddings-howell

Vannessa, Robinson

Mojtaba, Al-modhafir

Taylor, Banks

Joel, Shreve

Briana, Lamar

Roxsanna, Collins

Roslyn, Mcgee

William Prechel, D.O.

View All Details

Phone Number
(313) 584-3624
Office Locations
16551 W Warren Ave
Detroit, MI 48228

What Is the Silver Plan?
ObamaCare’s Silver Plan is a type of Metal Plan on the Health Insurance Marketplace. Silver Plans qualify for both Tax Credits and Cost Sharing subsidies.Silver Plans have lower out-of-pocket costs than Bronze Plans but higher out- of-pocket costs than both Gold and Platinum Plans. All Silver Plans share the same minimum health benefits, but the way they charge out-of-pocket costs can differ significantly.
How are Silver Plans different than other Obamacare health plans?
The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Silver Plan pays 70% of covered medical costs for a typical enrollee. Silver Plans are also the only metal plans which offer cost-sharing reduction (CSR) versions to consumers that require financial assistance for out-of-pocket costs.
How much does a Silver Plan cost?
The monthly premium for a Silver Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and the region in which you live. You can use HealthPocket’s comparison tool to compare Silver Plan premiums in your area.
When Can I Enroll in a Silver Plan?
The Open Enrollment period for the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.

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County
Applicant Info
Applicant
Date of birth
//
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male
female
Income
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MyPriority HMO Silver 5500

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Benefits & Coverage

Costs for Medical Care

Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

Exclusions and Limitations

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